Mental defeat is associated with suicide intent in patients with chronic pain

Objective:\ud Mental defeat has been implicated in precipitating suicide with effects not explained by depression. It has also been found to be elevated in people who are most distressed and disabled by chronic pain. This study examined the role of mental defeat in predicting suicide intent among chronic pain patients and compared the predictive value of mental defeat with other established pain and psychological constructs.\ud Methods:\ud Sixty-two chronic pain patients attended a semi-structured interview to assess pain characteristics and suicidality (present and worst-ever) and completed self-report measures of anxiety, depression, hopelessness, self-efficacy, pain catastrophising and mental defeat.\ud Results:\ud A total of 22.6% of people reported a history of suicide attempt (1 attempt=12.9%;≥2 attempts=9.7%). The wish to die was reportedly moderate to strong for 63.3% of those who attempted suicide. No significant correlations were found for hopelessness and self-efficacy with suicide intent in this sample. Hierarchical regression analyses suggested that pain intensity was a significant predictor of worst-ever suicidal intent (R=0.11), and mental defeat significantly improved the prediction even when the effect of pain intensity was accounted for (RΔ=0.12). Anxiety, depression and pain catastrophising were significant correlates of suicide intent, but they did not add to the prediction of worst-ever suicide intent after the effect of pain intensity was controlled for.\ud Discussion:\ud Mental defeat may be a key indicator for heightened suicide risk. Therapeutic interventions targeting mental defeat offer a novel avenue for reducing suicide risk in chronic pain patients.

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